Support essential for GP eligibility expansion

The expansion of free GP care to children aged six and seven is currently taking place. It marks the first stage of the expansion in eligibility for GP care without charges under the recent agreement between the Government and the IMO. It will be followed by the expansion to people earning up to the median income in September and November. In total, approximately 500,000 additional individuals are estimated to become eligible – 78,000 children and 430,000 individuals earning up to the median household income. This is the largest expansion in eligibility for GP care without charges
ever undertaken.

Given the scale of the plan, it is necessary to phase its introduction to avoid ‘logjams’ in the application process, according to the Department of Health. The opening of registrations for GP visit cards for children aged six and seven began earlier this month, while applications under the median income expansion will commence in two phases, on 11 September and 13 November.

The agreement with the IMO will put in place a series of capacity supports to allow GPs to recruit additional staff, as well as increases in fees to take account of the likely increase in demand for services. The total financial package will amount to approximately €130 million in a full year.

When the deal was announced, Dr Tadhg Crowley, Chair of the IMO GP committee, said it recognised the need for continued investment in general practice. GPs were already under significant pressure before the agreement. Speaking to the Medical Independent, Dr Crowley admitted the expansion of general practice teams under its terms would not address the impact of GP shortages.

While Dr Crowley said the deal was positive, he noted it did not address GP recruitment or physical infrastructure. These will need to be covered in a new GP contract. A new contract will be informed by the strategic review into general practice, which commenced earlier this year. The review, with input from stakeholders, will identify the challenges facing general practice in delivering a sustainable service into the future, and set out the actions necessary to address those issues in the context of delivering on the principles of Sláintecare. It will draw on feedback from the HSE and general practice, including through consultation with the ICGP and the IMO.

The review is due to be completed by the end of this year, and negotiating a new contract will obviously take time. However, some shorter-term initiatives are in train to seek to mitigate the recruitment and workforce difficulties facing the specialty. For example, in June it was announced GP training places are set to increase by one-third by 2024 and, in addition, there will be large expansion in the non-EU GP training programme.

The coming months will be uncertain for general practice, but it is a period that will go a long way in determining the future working lives of GPs. Free healthcare is a worthy aspiration; however, substantial ongoing support is essential to ensure GPs can manage the workload in a sustainable way.